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Case Reports
. 2024 Jul 24;8(5):605-608.
doi: 10.1177/24741264241262104. eCollection 2024 Sep-Oct.

Successful Closure of an Idiopathic Macular Hole With Topical Therapy After Failed Surgery

Thiago José Muniz Machado Mazzeo  1 , Gabriel Castilho Sandoval Barbosa  1 , Renato Silva Filho  1 , Raimunda Cristina Mendonça Freire  1 , Cleide Guimarães Machado  1   2 , André Marcelo Vieira Gomes  1
Affiliations
Case Reports

Successful Closure of an Idiopathic Macular Hole With Topical Therapy After Failed Surgery

Thiago José Muniz Machado Mazzeo et al. J Vitreoretin Dis. .

Abstract

Purpose: To describe the successful closure of an idiopathic macular hole (MH) with topical therapy after surgery failed. Methods: A case report was evaluated and prospective literature review performed. Results: After surgery to correct an MH in a 57-year-old female patient failed, topical therapy was initiated. MH closure was successful using this modality. Conclusions: There are few reports in the literature describing successful closure of an idiopathic full-thickness MH with topical therapy after initial surgery fails. This reinforces the importance of the "hydration" hole in this disease. Characterization with optical coherence tomography may help determine which patients could benefit from topical treatment for MH closure and avoid costly and invasive surgical procedures.

Keywords: dorzolamide; idiopathic macular hole; macular hole surgery.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of the article.

Figures

Figure 1.
Figure 1.
(A, B) Color and (C, D) red-free filter fundus images. (A, C) Unremarkable fundus images. (B, D) A significant macular hole is seen.
Figure 2.
Figure 2.
(A) Optical coherence tomography (OCT) of the right eye shows a detached posterior vitreous with an unremarkable neurosensory retina. (B) OCT of the left eye shows a full-thickness macular hole measuring 633 μm (minimum internal diameter). Cystic alterations are seen in the outer and inner plexiform layers.
Figure 3.
Figure 3.
Chronologically arranged optical coherence tomographic images. (A) Preoperative image as seen in Figure 2B. (B) Initiation of topical treatment on postoperative day 45 shows the macular hole is still open after surgery, even though its minimum internal diameter was significantly reduced to 182 μm. Intraretinal fluid accumulation persists, and more significant cysts seem to localize in the outer plexiform layer than in the inner plexiform layer. (C) Four months postoperatively (approximately 8 weeks after initiation of topical treatment), the external limiting membrane (ELM) was reestablished. A significant defect is seen in the foveal photoreceptor layer. (D) Eight months postoperatively, the ELM shows a minimal defect in the foveal photoreceptor layer.
See this image and copyright information in PMC

References

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